Enap

Enap – APF inhibitor.

Enap's list and form of release

Drug produce in the form of tablets in a dosage 2,5 mg, 5 mg, 10 mg and 20 mg. The operating drug component – enalapril a maleate.

Additional components: monohydrate of lactose, hypro rod, magnesium stearate, talc, hydrosodium carbonate, corn starch.

In blisters on 10 tablets. On 20 tablets in cardboard packaging (on two blisters).

Enap's analogs are the following medicines: Berlipril, Enalozid, Enam, Ednit, Enalapril, Enafarm, etc.

Pharmacological action

According to the instruction Enap is APF inhibitor, anti-hypertensive drug and "pro-medicine" as a result of which enalaprilat is formed. The mechanism of action of Enap is called by oppression of activity of APF occurring under the influence of enalaprilat. It leads to decrease in systolic and diastolic arterial pressure, and also decrease in load of a myocardium.

According to reviews Enap more expands arteries, but not veins. Significant reflex increase in ChSS at the same time is not observed.

In therapeutic limits the lowering of arterial pressure does not influence cerebral circulation and against the background of reduced pressure the blood stream in vessels of a brain is supported at the sufficient level. Besides, Enap's use causes strengthening of blood supply of a renal and coronary blood-groove.

Prolonged use of Enap causes reduction of myocytes of walls of arteries of resistive type and decrease in a hypertrophy of a left ventricle of a myocardium, slows down development of dilatation of a left ventricle and prevents development of heart failure. Blood circulation of an ischemic myocardium improves.

Enalapril inhibits aggregation of thrombocytes and has weak diuretic effect.

Drug or Enap's analog begins to work approximately in an hour after its reception, and in four hours reaches a maximum. Drug for days works.

Indications to use

Enap according to the instruction is shown at arterial hypertension.

The indication to Enap in combination with other medicines are:

• chronic heart failure;
• dysfunction of a left ventricle without the expressed symptoms.

Contraindications

In the instruction to Enap the following contraindications are specified:

• porphyria;
• hypersensitivity to enalapril and additional components of drug;
• Quincke's disease in the anamnesis;
• period of pregnancy and breastfeeding;
• children's age up to six years.

According to reviews Enap it is necessary to appoint with care at:

• stenosis of renal arteries;
• diabetes mellitus;
• hyperpotassemias;
• idiopathic hypertrophic subaortal stenosis;
• primary hyper aldosteronism;
• aortal stenosis;
• coronary heart disease;
• renal failure;
• general diseases of connecting fabrics.

Route of administration of Enap and mode of dosing

According to the instruction Enap is intended for intake. It is more preferable to accept drug in identical time for achievement of the greatest therapeutic effect.

At arterial hypertension the recommended dosage of drug or Enap's analog makes 5 mg once a day, with gradual increase in a dosage, but not more often than once in two weeks. As a rule, the supporting dosage makes 10-20 mg a day. The maximum dosage in days – 40 mg. To divide reasonablly too high dosage into two receptions.

For the patients accepting diuretics, the initial dosage of enalapril makes 2,5 mg a day.

At a hyponatremia or content of serumal creatinine more than 140 µmol/l the initial dosage of drug should not exceed 2,5 mg a day.

At diseases of kidneys the dosage is defined depending on indications to Enap and from renal function. At KK more than 30 ml a minute the initial dosage should not exceed 5 mg a day; at KK less than 30 ml a minute – no more than 2,5 mg a day, with gradual increase in a dosage to optimum.

In old age administration of drug or Enap's analog can cause lengthening of time of its action and more expressed hypotensive effect therefore the initial dosage should not exceed 1,25 mg, with gradual increase it to optimum.

At chronic heart failure the initial dosage of Enap according to the instruction makes 2,5 mg once a day, with its gradual increase to optimum, but than every two weeks is not more often. On average, an optimum dosage – 10-20 mg a day.

For treatment of asymptomatic dysfunction of a left ventricle the recommended Enap's dosage makes on 2,5 mg twice a day, with its gradual increase up to 10 mg two times a day.

Most often treatment by Enap long, usually throughout all life if there are no undesirable side effects demanding it cancellation.

Overdose

The overdose by Enap according to reviews causes a severe lowering of arterial pressure, up to development of a myocardial infarction, a collapse, thromboembolic disturbances or an acute disorder of cerebral circulation. Often the overdose is followed by spasms and a stupor.

Treatment needs to be carried out the following:

• the patient to put on a bed with a low headboard;
• in case of easy overdose it is recommended to make a gastric lavage and to carry out a symptomatic treatment;
• at more hard cases it is necessary to hold a number of events with the purpose to stabilize pressure (introduction in/in physical solution and plasma substitutes, a hemodialysis).

Side effects of Enap

According to reviews Enap causes the following by-effects which, as a rule, have slight character and do not demand drug withdrawal:

• Cardiovascular system: a retrosternal pain, an orthostatic collapse, decrease in the ABP, arrhythmia, pains in heart, heartbeat, Reynaud's syndrome, a thromboembolism of branches of a pulmonary artery.
• Sense bodys: sonitus, vision disorder and hearing, disturbance of a vestibular mechanism.
• Peripheral and central nervous systems: headache, confusion of consciousness, dizziness, drowsiness or sleeplessness, increased fatigue and weakness, depression, paresthesias.
• Respiratory system: bronchospasm, hoarseness and pharyngalgia, cough, pharyngitis, rhinorrhea, asthma.
• Alimentary system: vomiting, abdominal pain, lock or diarrhea, nausea, pancreatitis, increase in activity of liver enzymes, intestinal impassability, abnormal liver functions.
• Metabolism: hyponatremia, hyperpotassemia.
• Urinary system: giperkreatininemiya, proteinuria, renal failure.
• System of a hemopoiesis: agranulocytosis, thrombocytopenia, eosinophilia, neutropenia.
• Allergies: Quincke's disease, photosensitization, small tortoiseshell, skin rash and itch, exfoliative dermatitis.
• Dermatological reactions: alopecia, pempigus.
• Other side effects: inflows, increase in SOE, decrease in a libido and potentiality.

Storage conditions

Drug Enap is stored at the room temperature not longer than 36 months.